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ICU Nephrology

pre-dilutional versus post-dilutional CVVH

There are two general strategies for CVVH replacement solution entering into the blood circuit: pre-dilution (in which replacement solution is mixed with the blood prior to its entry into the filter), or post-dilution (in which replacement solution is…

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The MRI above depicts a classic example of posterior reversible encephalopathy syndrome (PRES), sometimes also called reversible posterior leukoencephalopathy, an increasingly-recognized consequence of malignant hypertension.  The whitish areas (“hyper-intense signal”) in the bilateral occipital and parietal lobes represent…

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Propofol Infusion Syndrome

Though rare, propofol infusion syndrome (PRIS) is a cause of acute kidney injury in the appropriate ICU setting. As we all know, propofol is an intravenous sedative currently favored in the ICU due to relatively short half-life and…

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Have you ever given THAM (tromethamine)? For whatever reason I was completely unfamiliar with the drug as a resident, but it is given not infrequently in the surgical ICU’s in the hospitals in which I’ve worked as a…

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Treatment of Sepsis

I heard a talk on “Sepsis & Renal Failure” today, which reviewed much of the recent evidence-based medicine trials regarding the treatment of sepsis in the ICU. Honestly, the main message I came away with was this: most…

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Troubleshooting CVVH

Even though most studies have not shown any mortality benefit to CVVH when compared to intermittent hemodialysis, that doesn’t mean that we don’t use CVVH all the time. At our centers (Mass General Hospital and Brigham & Women’s…

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Renal Assist Device

I reviewed a paper in our Renal Journal Club today–Tumlin et al, Efficacy and Safety of Renal Tubule Cell Therapy for Acute Renal Failure in a recent 2008 issue of JASN–which tests a novel device termed the “Renal…

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CVVH Basics

CVVH (continuous venovenous hemodialysis) is the form of CRRT (continuous renal replacement therapy) used in our hospital. Although most studies have not shown a mortality benefit in patients treated with intermittent hemodialysis versus those treated with CVVH, in…

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